Comparison Of Medication Treatment Versus Cognitive Behavior Therapy Of Hoarding Behaviors In Obsessive-Compulsive Disorder C.M. Powers, PA-S & T. Quigley, MPH, PA-C Department of Physician Assistant, Wichita State University ABSTRACT Obsessive-compulsive disorder (OCD) can be difficult to treat due to patient non-compliance and treatment efficacy. This anxiety disorder presents in behaviors such as checking, washing, repeating/counting, ordering/symmetry, harming obsessions, religious/sexual obsessions, obsessional slowness, pure obsessions and hoarding. Of these behaviors, hoarding is the most difficult to treat. Hoarding is defined as the inability to throw away items that are useless. Objective: To determine the best possible therapy for individuals with hoarding behaviors comparing the use of psychotropic medications, cognitive behavioral therapy (CBT) or both. Method: A comprehensive evidence-based medicine (EBM) literature review was conducted using Medline, PubMed, and FirstSearch databases. Included articles were published in English between 1995 and the present. Studies were then ranked from Levels 1, 2 and 4 based on the quality of the study design. Level 3 articles were not available for this topic of study. Results: Of the 16 studies that met the inclusion criteria in the EBM analysis, five were used primarily as background information, one supported the use of medication along with CBT, two supported the use of CBT alone, one did not support the use of medications alone, two did not support the use of CBT alone, and five were inconclusive. Conclusion: This analysis warrants a Level C recommendation (inadequate number of Level 1, 2 or 3 studies) for use of medications with CBT, medication treatment alone or CBT alone. STUDY PURPOSE The purpose of this study is to determine the best possible therapy for individuals with hoarding behaviors regarding the use of medications, CBT or both. Hoarding is the most difficult subcategory of OCD to treat. Poor response to cognitive behavioral therapy (CBT) and medications. Anxiety levels are higher in people with hoarding symptoms Ability to gain insight on treatment benefits is decreased. Decreased compliance to treatment. METHOD Comprehensive evidence-based literature review. Peer-reviewed literature was obtained by searching Medline, PubMed, and FirstSearch databases. MeSH terms: hoarding, hoarding disorder, obsessive compulsive disorder, treatment of hoarding, and treatment of obsessive compulsive disorder. The data was linked to the hypothesis of the study. Some articles included in this literature review were used for the sole purpose of background information. All articles were published in English between 1995 and the present. Levels of Evidence: • Level 1 (evidence obtained from at least one randomized controlled trial) • Level 2 (evidence obtained from one or more cohort study) • Level 4 (evidence obtained from case-series or expert opinion) • Level 3 (evidence obtained from one or more casecontrol study) articles were not available for this topic of study. Exclusion criteria: • Articles which focused primarily on the overall treatment of OCD but did not include the treatment of hoarding. RESULTS Of the eleven studies included in the literature review, three were Level 1, and four were Level 2. Studies that would be rated Level 3 were not available for this research topic. It was necessary to include four studies which met Level 4 criteria due to the lack of investigation of this particular topic. Two studies supported the use of CBT alone. Two studies did not support the use of CBT alone. One study did not support the use of medications alone. One study supported the use of medication along with CBT. Five studies were inconclusive. Table 1 represents a categorized break down treatment types, if the treatment was efficacious, non-efficacious, or inconclusive and what level of evidence the studies ranked. The studies are differentiated by author. CONCLUSION This analysis warrants a Level C recommendation (inadequate number of Level 1, 2 or 3 studies) for the use of medications with CBT, medication treatment alone or CBT alone. More research must be performed and data obtained from Level 1 and 2 studies to search for the most effective treatment of hoarding. This patient population often does not recognize the seriousness of their illness and are non-compliant.